A failure of communication proved to be life-threatening for Bengt Bostrom.

Bostrom, 71, of Coppell, Texas, went to his internist, Dr. Bradley Jones, to figure out why he was so exhausted. Bostrom was already being treated for prostate cancer, and a specialist had prescribed naproxen to help reduce swelling.

If Jones had known that, he'd have added a medicine to protect Bostrom's stomach. Instead, Jones didn't find out until he noted how unnaturally pale Bostrom was, ran tests and sent him to the hospital, where he required four units of blood to stabilize a bleeding ulcer.

"I didn't suspect the medication," Bostrom says, noting that the naproxen, which Jones identified as the culprit, was an over-the-counter pill he'd only taken four or five days.

Jones, an internist on staff at Baylor Medical Center at Irving, Texas, says the incident points out the importance of having one doctor monitor all of a patient's medications - prescription, over-the-counter and herbal.

"The internist is the quarterback of a patient's care," Jones says. "The internist needs to make the referrals, and if you self-refer, the specialist should send a report back so the internist can say this medicine is fine or there's a reason why we can't do this medicine."

Armon Neel Jr., a fifth-generation pharmacist and author of "Are Your Prescriptions Killing You?" (Atria Books, $25), might add that a board-certified pharmacist, working with that doctor, can play a key role as well.

About 46 million people in the United States have multiple chronic health conditions that require multiple medications and rely on multiple health care providers for their care, according to the Alliance for Integrated Medication Management, an organization created in June with the goal of integrating pharmacists into primary care services with the help of the Health Resources and Services Administration of the U.S. Department of Health and Human Services and the Centers for Medicare & Medicaid Services.

Medication-related problems are common, costly and hurt people, according to a 2012 report from the American Geriatrics Society. Problems can occur when medications are taken incorrectly or conflict with one another or with certain foods and alcohol.

Fatal prescription interactions can occur at any age, as witnessed by the case of actor Heath Ledger, who died in 2008 from an accidental overdose of six prescription drugs, including painkillers, sleeping pills and anti-anxiety medication.

However, Dr. Paul E. Carns, an anesthesiologist and assistant professor of anesthesiology at the Mayo Clinic in Rochester, Minn., says that the most vulnerable are the elderly, who use an average of 16 medications apiece, often prescribed by different specialists and acquired at different pharmacies as patients shop for the best prices.

"As we get older, we have more chronic conditions that require multiple medications that are more powerful than ever before," he says. "Many work specifically on certain places in our body, and many times there's an interaction."

The problem extends to over-the-counter medications taken in excess, from fever reducers such as Tylenol, which can damage the liver, and anti-inflammatory medications such as Advil, which can affect the kidneys, he says.

Additional interactions to watch for: certain beta blockers can have an adverse effect on blood sugar; anti-inflammatory medicines can raise blood pressure; some antibiotics and high doses of grapefruit can inhibit the metabolism or breakdown of statins in cholesterol medications; coumadin, a blood thinner, can be blocked by too much vitamin K, which comes from eating green vegetables.

Neel offers a long list of potentially adverse reactions in his book, pointing out how patients taking blood pressure drugs should be monitored for muscle pain, migraines, blackouts, diabetes and kidney failure.

So how should patients manage?

A pill dispenser, in which pills are organized for morning and night and days of the week, can help patients keep track of when to take the proper medications.

Carns advises patients and caregivers to keep a medication list on them at all times, know what their medications are used for, and be sure to include over-the-counter medicines, herbal supplements and vitamins on the list for a doctor to see. While he goes over all medications with his patients, he will also order a pharmacy consultation for patients who need additional help.

Jones says it's important for both the patient and the internist or family practitioner to recognize that the list of medications may need regular adjustments.

One of his patients, Paul Mason, 85, of Flower Mound, Texas, is happy with the care he received for his heart attack by a specialist in the emergency room. But the cardiologist prescribed a commonly used beta blocker that Jones had prescribed and rejected earlier because it worsened Mason's asthma.

As Mason struggled with his breathing, Jones switched him to a different beta blocker that eased his wheezing and adjusted the dosage of other medications he was taking to control cholesterol, blood pressure, a bladder problem, chronic obstructive pulmonary disease and Type 2 diabetes. Jones shared the changes with the cardiologist and discussed them with Mason.

"After 10 days of treatment with the different drugs, Dr. Jones and I agreed to drop some and continue and add others. I'm feeling so much better," Mason says.

As for Bostrom, he keeps a list of all his medications in his wallet, takes only the ones that have been cleared by Jones, and reports back when he feels they need to tinker with the balance.

Communication, they agree, is key to getting it right.

"I had one medication that gave me a cough and he switched me to something that doesn't. We're doing good together."

TIPS FOR MONITORING PRESCRIPTIONS

n Compile a personal medication dossier, keep it up to date, and show it to all doctors and health care professionals you see on every visit.

n If you don't know why you're taking medications on the list or are not sure how to take them, ask.

n If you're taking more than one medication for the same condition, ask why.

n If you are taking medications prescribed by doctors you don't see on a regular basis, ask your primary care physician whether you still need to take them.

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